Sunrise Community Health
Center in Greeley has to turn away dozens of people each day who call hoping
to see a doctor. Sunrise would benefit from the estimated $175 million a year
Amendment 35 would raise.
Greeley - When Sarah Walsh
needs to see a doctor, she rises early and starts dialing her local clinic at
7:30 a.m.
If all 10 lines at Sunrise Community Health Center in Greeley are busy, she
pushes the redial button every few seconds.
Walsh is 72. She has diabetes,
glaucoma and a surgically repaired heart and depends on the clinic for medical
care and discounted drugs.
But first she has to win
the daily competition for an appointment.
"Sometimes, you don't get through," she said. "I've gone almost
a week, calling every day."
Each day, the Sunrise center
turns away dozens of people calling for a doctor. It is betting on higher tobacco
taxes to change that.
Colorado's community health
centers have become leading contributors to a citizen campaign that would raise
an estimated $175 million a year by increasing state cigarette taxes from 20
cents to 84 cents a pack.
Their umbrella organization,
the Colorado Community Health Network, has donated more than $250,000 so far
to the campaign for Amendment 35.
The health centers also
would become leading beneficiaries if the tax increase passes. The initiative
promises them an estimated $33 million a year.
"It'd be a huge return
on investment," said Sunrise clinic director Mike Bloom.
At the Greeley clinic, a
converted 19th-century schoolhouse, scheduling coordinator Consuelo Villalvilla
estimates 60 to 80 patients get turned away each day.
When she arrives at 7:30
a.m., callers have been holding for half an hour, "and we also have a line
of patients waiting outside," she said.
Bloom envisions doubling
the clinic's examination rooms, hiring more doctors and wiping out waiting lines
with new tobacco-tax revenues.
"The day after Amendment
35 passes," he said, "I'll be signing contracts to create new space."
He isn't calling any contractors
yet.
In the 12 years since Colorado
passed an amendment requiring voter approval of new taxes, no statewide tax
increase has passed.
And if voters approve the
tobacco tax, a legislative fight over the money may follow.
The initiative specifies
that 46 percent of the new revenues would go to child health and Medicaid programs,
19 percent to health centers serving low-income patients, 16 percent to cancer,
heart and lung programs, 16 percent to discourage tobacco use and 3 percent
to local governments.
It also says the money must
supplant, not supplement, existing state support for several of those programs
on its effective date.
Many Colorado legislators
objected to those requirements on two grounds: It would embed spending formulas
in the state constitution, and it would forbid cutting selected health programs.
So they passed a bill this year that slashes state funding for those programs
to zero on the effective date of the tobacco initiative. The new law could thwart
much of what the initiative proposes to accomplish.
Community health centers,
for example, would get an estimated $33 million a year from the tax increase.
But their current government support totals
$51.4 million, and nearly half is state money, according to the Health Care
Policy and Financing department.
Sen. Ronald Teck, a sponsor
of the bill designed to counter the tobacco initiative, said legislators are
already hamstrung by constitutional amendments. State leaders say Colorado has
been plunged into a fiscal crisis by the contradictions between the Taxpayer's
Bill of Rights, which limits revenue and taxes, and a later citizen initiative
called Amendment 23, which mandates annual spending increases for K-12 education.
"Sometimes we have
to make choices about what programs live and what programs die," he said.
"If you have everything locked in the constitution, you have absolutely
no ability to do that."
Mike Melanson, the campaign
manager for the tobacco initiative, said that if it passes, proponents will
challenge the constitutionality of the new law as designed to interfere with
a vote of the people. And when the legislature meets, "there'll be a major
fight and a lot of public pressure to use these dollars for expansion of health
programs," he said.
Melanson acknowledges that
some contributors to the campaign stand to gain from the taxes it would generate.
Community health centers
would get unrestricted state funds. National Jewish Medical and Research Center,
another contributor, already has a state contract to help smokers quit and could
qualify for new money to detect and treat lung diseases.
Opponents of the tobacco
initiative call it overly restrictive. Its designers "attempt to predict
that this program will need X dollars and that program will need Y dollars.
I don't think they should be the ones to figure out how to use this money,"
said Beth Skinner, a fellow at the conservative Independence Institute. Besides,
"I think the health care crisis is not what the proponents make it out
to be," she said.
Yolanda Rivera would disagree.
While Colorado temporarily capped a health program for low-income children,
"my little girl, she was sick, she had a pair of kidney infections,"
she said.
Rivera, a mother of three
who is married to a machine operator in Lyons, carried the girl to a hospital.
Her daughter recovered,
but "I still owe money. Collectors are calling all the time," she
said. Now, "if they have fevers or terrible stomach pains, I can't take
them to the hospital. I use home remedies."
